Miva Merchant Order Information

Your Company Information

Primary Account Contact (For PayPal)

*Contact Name:

*Phone #:

Fax #:

*Email:

Secondary Contact

*Contact Name:

*Phone #:

Fax #:

*Email:

Merchant Account Provider (Acquirer Information)

Enter information about your Merchant Account provider, also known as your acquirer, and provide your account information below. This is the company, usually a bank, that your credit card account is set up through. This is the company that takes the percentage of each credit card charge and sends you the monthly account statements. If you need to contact them to find out some of this information, please read through the entire form first because there may be more information you need from them.

*Acquirer:

*Acquirer Contact:

*Acquirer Phone #:

*Merchant Account #:

Credit Cards / Checks Accepted

Specify which credit cards you are currently set up to accept, and which processing platform your merchant account provider (a.k.a. acquirer) uses for each type of card. If you do not know this information, you will have to get it from your merchant account provider as you won't be able to process cards without the correct processor selected. Once you have all the appropriate card types and processors enabled, you will need to fill out extended information about the specific processor(s) your merchant account provider uses in the next section; it may require information supplied by them.

AmEx®

Diner's

Discover

JCB

MasterCard

Visa

American Express® / American Express Brighton Playform Setup

Please complete the following information to complete your American Express® platform setup: